Case 41-2020: A 62-Year-Old Man with Memory Loss and Odd Behavior

Abstract

T h e ne w e ngl a nd jou r na l o f m e dicine Pr esentation of C a se Dr. David L. Perez: A 62-year-old, left-handed man was seen in the memory disorders clinic of this hospital because of memory loss, personality changes, and odd behavior. Approximately 5 years before this evaluation, the patient's wife noticed that the patient was becoming more forgetful and napped frequently during the day. She also noticed that he lacked initiative in his professional work; for example, he was not charging or collecting payments for services. The patient's coworkers observed that he was having difficulty focusing and frequently required redirection when interacting with clients. The patient had no concerns other than intermittent mild headaches. During the next few years, the patient's wife noticed that he became distant with family, was less talkative, and lacked interest in activities that he had previously enjoyed. He made numerous costly errors at work and also had odd behaviors. For example, he entered the kitchen of a local restaurant without permission; on another occasion, he inadvertently borrowed a vehicle from a colleague without first notifying that person. In another instance, while the patient's vehicle was stopped for a routine traffic infraction, he became irritable and briefly evaded police, incurring several legal violations. One year before this evaluation, the patient was seen in the neurology and psychiatry clinics of another hospital at his wife's request. He had no concerns about his neurocognitive state. He noted that he was sleeping as little as 2 to 3 hours per night but had a good energy level. He reported intermittent mild headaches. He had no sinus pain, numbness, tingling, or constitutional symptoms. On examination , the patient was alert and oriented, with some inattention and confabula-tion. The remainder of the neurologic examination was normal. A complete blood count and blood levels of electrolytes and glucose were normal, as were results of tests of kidney, liver, and thyroid function. Tests for antinuclear antibodies and for